第三脑室手术入路临床应用的对比研究

Comparison of clinical application of surgical approaches to the third ventricle

目的 比较几种常用的第三脑室手术入路临床应用效果,探讨切除第三脑室肿瘤适宜的手术入路.方法 采用经额叶皮质-侧脑室入路、经终板入路、幕下小脑上入路切除第三脑室肿瘤35例（前期组）;采用经胼胝体-穹隆间入路切除第三脑室肿瘤21例（后期组）,两组均在显微镜下切除肿瘤,观察比较手术效果.结果 前期组肿瘤全切除16例,次全切除6例,部分切除13例;后期组肿瘤全切除11例,次全切除8例,部分切除2例.两组全切除和次全切除率差异有统计学意义.后期组术后并发症发生率明显少于前期组.结论 经胼胝体-穹隆间入路路径直接,术野暴露清楚,较易切除肿瘤,术后并发症少,是切除位于第三脑室中、后部肿瘤可选择的手术入路.

Objective To compare the application effect of several approaches to the third ventricle,and explore the optimal approach to resect the tumors located at the third ventricle. Methods Under the operative microscope thirty- five patients （prophase group） with the third ventricle tumors were operated via transcortical approach, trans - lamina terminalis approach or infratentorial supracerebellar approach, and twenty- one patients （anaphase group ） via transcallosal - interforniceal approach. Operative effect was observed and compared. Results Among the prophase group, the tumors were totally removed in 16 cases,subtotally in 6 cases and partially in 13 cases. Among the anaphase group, the total removal of tumor were obtained in 11 cases, subtotal in 8 cases and partial in 2 cases. Rate of total and subtotal tumor removal had significant difference between two groups. Rate of postoperative complications in anaphase group was lower than that in prophase group. Conclusion Transcallosal - interforniceal approach should be considered for treatment of tumors involving the middle and posterior portion of the third ventricle by providing a quite large operative field ,direct corridor, easier tumor resection and rare postoperative complication.